Operation+Shot+in+the+Arm

Melissa D
 * || =Giving H1N1 a Shot in the Arm - //House// Style=

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Are you a healthcare worker who will be giving the H1N1 vaccine to patients in the near future? Are you looking for a reliable source of information about the vaccine but you don't have the time to sift through pages of information online? Would it be fun to team with familiar faces for a crash-course overview of the vaccine and then practice your performance in a virtual environment? Join the cast of the television series //House//, and the experts at the U.S. Department of Health and Human Services, for your H1N1 vaccination rotation on the frontlines at Princeton Plainsboro Teaching Hospital, the fictional location of the hit medical drama. ======

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In this online experience available at an official government H1N1 website, your experience begins (first person "walk and talk" style) as a licensed healthcare professional who is called in to cover a shift at the busy walk-in clinic at the hospital. You are greeted in the lobby by a young hospital volunteer and rushed into the tail end of a packed H1N1 briefing with hospital staff led by Dr. House and visiting experts from the Centers for Disease Control and Prevention (CDC) who are on site investigating a surge in local H1N1 cases. There is concern that the surge may indicate another wave of the pandemic outbreak. Most of the staff present look like they haven't been home in days. Some are distractedly sipping coffee while others nod off until they are startled back to attention with a poke from a colleague. Dr. House is pacing in front of the whiteboard easel, casually spinning a menacing-looking vaccine injection gun from the 1976 swine flu immunization campaign that he found in the basement, while his staff recite the current case counts, projections for the current wave of the pandemic, and latest vaccine information. He sets his gaze on you; sizing you up. ======

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As you file out of the glass-walled briefing room with the others, the volunteer from the lobby grasps your elbow and guides you toward the hospital clinic where the line of people waiting for immunizations continues out the door and staff rush about tending to the ill, those seeking vaccine, and the worried well who do not have symptoms but fear they may be ill from a suspected exposure. She delivers you to hospital administrator, Dr. Lisa Cuddy, and disappears. Dr. Cuddy directs you to your exam room and informs you that your screening nurse is on break, Dr. House and his staff are covering for the infectious disease department who usually supervise vaccination clinic, and Dr. House is available by pager if you need assistance but his team is busy in the ICU attending to critically ill H1N1 patients. She points to the vaccine reference materials on the counter and the computer workstation in the corner. "Thanks so much for coming in," she says with a hurried smile over her shoulder as she moves on to her next crisis-in-waiting, just missing a head-on collision with your first group of patients who are elbowing their way toward your exam room. "Can you come back tomorrow?" she calls. ======

Instructional Objective
Pandemic H1N1 influenza vaccine manufacturing continues and delivery to health providers is expected to continue over the next several months. Up until recent weeks, the Center for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) had been recommending vaccination for certain priority groups identified to be at a higher risk for complications. Now, due to increased supply and declining demand from the target populations more individuals are now eligibleto receive the vaccination. To date, most providers who have received vaccine supply are those who serve children and pregnant woman, two of the highest population risk categories. As more vaccine becomes available, additional healthcare workers will begin administering the H1N1 vaccine and will need to become familiar with the various formulations available and the patient screening criteria.

This proposal outlines a public health/entertainment industry partnership to develop an online simulation including live actors and interactive patient encounters. The purpose of this project is to support vaccinators in accurately delivering the H1N1 vaccine in their workplaces by allowing them to learn and practice in a safe and engaging environment with feedback and directed exploration of the most pertinent resources they need to be familiar with to keep up to date on the latest information.

Specifically, the learners will be able to:
 * determine whether a simulated patient is eligible to receive H1N1 vaccination based on current guidelines,
 * discuss the purpose, contraindications, and risks associated with the vaccine and H1N1 with the patient,
 * locate resources for specific (and official) information on the vaccine or related topics,
 * choose the appropriate vaccine and dosage for a simulated patient given the information provided by the patient and vaccine guidance, and
 * complete the appropriate documentation and give follow-up care instructions to the patient.

Learners
Learners for this activity are currently licensed and active healthcare workers in the Unites States who are qualified to screen for vaccinations, or deliver vaccines, and have access to the Internet. This may include nurses, paramedics, physician assistants, pharmacists and physicians. Education ranges from associate to doctorate-level degrees. Age range for the target population is approximately 22 - 75 years. Learners may be required to perform vaccination as part of their job responsibilities, or they may be volunteering to help at busy clinics in their communities out of a sense of civic duty. Although the product would likely be marketed specifically to healthcare workers, it may draw general patient and public interest given the involvement of a popular television series and the presentation of information on a current pandemic influenza.

Context of Use
== This simulation is designed for use by individual healthcare workers at home or in an office environment on individual workstations, or mobile devices capable of the final bandwidth and interactivity requirements. Since it is web-based, it could be used in a group environment if projected onto a large screen, however the interactive involvement by each learner would be limited and individual follow-up after the session would be recommended. Since the targeted healthcare workers already have vaccination training, if not extensive experience giving shots, the activity is designed to build upon prior knowledge of influenza, vaccination techniques, current equipment, screening techniques and documentation. Multiplayer functionality and repeat play would not be necessary to support the primary learning objectives and interest in such features is anticipated to be low. ==

Scope
This simulation will be targeted to H1N1 vaccine administration and is designed to be a brief exercise for the participant and mimic an on-the-job training situation common to many healthcare environments where staffing is short and patient volume is high. A fairly complete journey through the presentation and simulation should be accomplished within 15-20 minutes but should also be able to accommodate longer sessions for those desiring more practice (up to 30 minutes).

Specifically, using the introductory video, interactive patient scenarios, and reference resources, the simulation will INCLUDE: Items one and two will be presented as ‘talking points’ that can be transferred to the patient briefing task in item three.
 * 1) Pandemic H1N1 influenza disease overview (BRIEF)
 * 2) Definition of pandemic
 * 3) Definition of seasonal flu
 * 4) High risk categories
 * 5) Vaccine campaign and target populations
 * 6) Vaccines types
 * 7) Patient briefing and screening for contraindications
 * 8) Vaccine dosages
 * 9) Basic administration
 * 10) Documentation (consents, if applicable and Vaccine Information Statements (VIS) forms and instructions
 * 11) Feedback on responses (integrating video of House characters supporting or redirecting based on accuracy or judgement)

The project will EXCLUDE the following topics: Note: Reference sources for current guidance on each of the topics listed above will be provided and participants will be encouraged to register with the official system to receive updates via email as they become available.
 * 1) Diagnosis and treatment of H1N1
 * 2) Use of antiviral medication
 * 3) Laboratory testing, surveillance or epidemiology
 * 4) Detailed recommendations on the use of Personal Protective Equipment (PPE) and infection control procedures for healthcare workers
 * 5) Guidance for healthcare professionals caring for ill patients
 * 6) Adverse events reporting

Object of the Game
The goal of the game is to accumulate enough points representing correct choices presented during each patient encouter to accurately screen and/or vaccinate at least 15 patients out of 18 presented representing the target groups. Learners will have opportunities during each encounter to refer to guidance documents, page staff for a consult, or (after multiple failed attempts, choose to have the correct answer revealed).

Competing Products
//Sid the Science Kid Flu Vaccination Special Episode – Getting a shot: You can do it! -// The U.S. Department of Health and Human Services and the Association for Prevention Teaching and Research worked with the Henson Company and its partners to create a special episode of the Sid the Science Kid series, a cartoon targeting young school-aged children. It aired on PBS on Monday, Oct. 26, 2009, with subsequent airings in November and December. While this product is not a game, it does show precedence of HHS partnering with current media programming to educate an audience on a vaccine-related topic. In this episode Sid and his family discuss the flu vaccine and Sid's grandmother (a nurse) administers the vaccine to the students in his class at school. This episode provides a basic understanding of how the vaccine works, how people catch the flu from others and what everyone can do to stay healthy.

//Public Health Dispensing Game// - The current proposal is largely inspired by a public health game that I reviewed last year. The current proposal is similar to the P.O.D. game in that the learner has to:
 * quickly distribute p rophylaxis to large quantities of people;
 * possibly work in an unfamiliar environment,
 * rely upon on the job training and resources on site (people or information),
 * focus solely on the task at hand (distributing medication not diagnosing other problems).

Difference between the P.O.D. game and this proposal include:
 * P.O.D. game is a hypothetical planning response to an Anthrax threat/release (distributing pills) scenario
 * H1N1 is current virus spreading around the world requiring vaccination (performing a medical procedure; providing vaccine vs pills),
 * P.O.D. game is set in a large auditorium where the public waits in lines to go through the stations vs. H1N1 is very commonly given in existing clinic environments such as the clinic in //House//. This is based on several factors including the limited availability of vaccine during the fall (therefore not enough doses to supply large public venues), and the fact that many private providers and public health centers are familiar with providing vaccinations and it makes sense to utilize those resources and avenues of patient access.
 * the current proposal adds the look and feel of the //House// television show. It provides a vivid, and urgent storyline that allows the participant to stay connected with the real-world status of the pandemic while engaging in the fantasy world associated with the //House// set and characters.

The //HOUSE// //Daily Dose Game// This appears to be an online game on the official Fox website for House. After multiple attempts, I have not been able to activate the game so I am not sure if it was meant to be functional. It appears to be a race game based on the goal to catch pills (presumably falling) to get 15 points before the timer runs out. It gives directions to use arrows to navigate and lists various pills and their point values. The game is referencing the Vicodin addiction of the lead character, Dr. House, which has been a recurring subplot of the series. In the past Dr. House has frequently been seen “popping” pills during office hours. He recently went through a rehabilitation program and episodes this season have included content regarding the struggle to regain his license to practice medicine and to stay clean and find alternate adaptations to manage his physical pain. More on the decision process to include this somewhat controversial character in this proposal will be covered in the design process narrative below.

Design Details
//Universal Elements// The goal is to film the required scenes exactly like the television show including the same settings, lighting, sound, and camera movements with the exception that all characters interact with the camera to enhance the illusion that the participant is actually able to self-project into the scenario (and the world of House) immediately. I believe this technique has been used in at least one House episode where the viewer experiences the episode from the perspective of the patient. It has also been used in movies and can be a very powerful tool in storytelling. The most recent example I viewed was the 2007 film The Diving Bell and the Butterfly

Given the gravity of existing illness and loss of life, and the potential for increased severity as the pandemic continues, the overall aesthetics of the game will be photo-realistic, professional, and grounding. Partnering with a government agency will also involve the careful negotiation of aesthetics and content that is both accurate and consistent with the usual media and public affairs requirements of agencies that strive to maintain the confidence of the population. Risk communication is especially critical during pandemics due to the widespread uncertainty, rumors, and potential for panic.

The interactions where the participant chooses from various content or action options should be subtle, natural, and secondary to the video presentations of the patients.

//Specific Elements//


 * ** Phase ** || ** Categorization ** || ** Visual ** || ** Content ** || ** Interaction **** State **** of Learner ** || **Design Notes ** ||
 * **Phase I** || Introduction video is the same for each learner. || High quality live-action footage

Locations (All existing //House// set)
 * 1) Lobby
 * 2) Elevator
 * 3) Glass-walled briefing room
 * 4) Hallway into clinic
 * 5) Clinic exam room interior
 * 6) Computer
 * 7) Reference documents

|| As described in the Overview section of this design document.

Characters No points. || Scenario, location, and goals established.
 * 1) House cast
 * 2) Actors as health officials (or actual staff)
 * 3) Extras (lobby, briefing, clinic
 * 4) Actors for patients || No learner input; passive introduction to scenario.

New work location, entering half-way through briefing and lack of orientation produces state of anxiety and motivation to acclimate and succeed.

Sting of pearls - step by step development of story. ||
 * ** Phase I ** ends with learner being left in exam room with patients moving in. ||
 * ** Phase II ** begins with same visual location (exam room) //__but interactive interface reveals around the video viewer__//.

The interactive interface is primarily based on the components in the model in the public health P.O.D module where there is a video viewer but also suggestions questions or actions to take. It also allows the participant to track time and score. ||
 * **Phase II** || Exam Room || Still from camera perspective, learner is healthcare professional in the House exam room. || Computer monitor display is visible with flashing notice that the archived version of the latest H1N1 briefing that the viewer only saw briefly is available for playback. || Interactive interface begins.

Participant can choose a one time pause of the video of the first patient in order to get familiar with the environment. || Playback of briefing covers the Concept and Context items listed in the @Content Analysis. ||
 * **Phase III** || Patient encounters || Individual video segments for each patient.


 * 1) Family of three
 * 2) Pregnant mother of two
 * 3) Schoolteacher, retired
 * 4) Cop
 * 5) Impatient patient
 * 6) Sniffling toddler
 * 7) Businessman
 * 8) Mayor
 * 9) House
 * 10) Neighbor who wants inside scoop || Participant is presented and interface shows severl several written choices of responses they could select (e.g. solicit additional information) or actions they could take (e.g. vaccinate or determine individual has contraindications and is not eligible)

Possible questions: choices.
 * What is the flu?
 * What is the difference between seasonal and H1N1?
 * I heard cases were down, why do I still need it?
 * How is it made?
 * Will it give me the disease?
 * Are you qualified to give me this vaccine?
 * What are the different types of vaccine?
 * What is thimerosol?
 * I am pregnant/breastfeeding; do I still need the vaccine?
 * Can I get seasonal and H1N1 at the same time?
 * Do I need a second dose?
 * Can my child have his\her other vaccinations today?
 * I forgot my shot record, how will I show my regular doctor that I got this vaccine?
 * What are the side effects?
 * Will the shot hurt?
 * I have had Guillain Barre Syndrome, should I get vaccinated?
 * I am allergic to eggs; they could kill me. Can I get the vaccine?
 * What do I do if I have a severe reaction?
 * How do I keep informed? || Learner selects

Can choose to page House and he or his staff will respond with additional information for a selected inquiry - pick list)

Points awarded for accuracy and time. || Learner will be given immediate feedback if their selection was accurate and the opportunity to choose another item or continue to next patient.

Borrowing from P.O.D model summary screen would show results, affirm teaching points.

Also include character feedback based on score (e.g. House rel ||

//Technical Elements//
 * Designed to be viewed and played online at a website. Flash, Captivate or backend of existing POD game.
 * Feel there is not enough time or value to expand to other applications.
 * Due to the urgency to produce in January, the interface would need to be as simple as possible without wasting time on tricks or gimmicks unrelated to the phases outlined above.

Motivational Issues
This proposal strives to inform a very specific target audience of a limited and well-defined scope of content so that they may accurately transfer the knowledge in the near future if tasked to perform H1N1 vaccinations (apply). The design relies heavily on at least some prior knowledge and experience with injections and vaccination so that the new content is limited simply learning about a new vaccine and the circumstances in which it is being advocated. This prior knowledge is assumed in that only certified or licensed individuals would be tasked for such roles. As discussed in the Design Process section below, this could be very dry and mundane learning accomplished simply by reading guidance documents or asking questions on site. Using the ARCS Motivation Model, the topic itself activates inquiry arousal and inherent relevance to the assigned task because most healthcare workers demonstrate a desire to do their job correctly. The novelty of the pandemic virus, the new vaccine, and the public education process may also spark extra attention to the topic.

Integrating the content with the existing fantasy world of the House television show allows the easy use of story and familiar aesthetics to support the mechanics of content (specifically screening guidelines and procedures.) For fans of the popular show there would be the opportunity to actualize the projection of self into the world of House and fulfill the desire to interact with familiar characters and environments. Even for participants who are not fans of the show, the core features of a healthcare environment are still in tact (hospitals and clinics environments are very similar from one location) and the House environment could easily be used as a generic healthcare template with which the participant should be familiar.

However, even though the healthcare environment is a piece of familiarity, by dropping the participant directly into the live action film and scenario, this proposal aims to amplify feelings of anxiety associated with the real possibility of needing to learn about H1N1 vaccination, regardless of profession or experience. The urgency of the debrief and the CDC investigation onsite of the surge in cases function to overcome any feelings of participant complacency about the pandemic threat itself and underscore the need for both the relevance of the vaccine campaign and education. Basically, the potential to do good is highlighted in Phase I.

In Phase II, as the participant is promptly plopped into an interactive scenario with patients without any true instruction or handholding, they must actively seek the resources and information they need to perform their job. They can access the guidance documents and/or choose to watch a replay of the briefing they missed most of on the hospitals intranet.

The intentions of this project are not to provide a detailed experience based on strategy, risk or competition. This along with the briefness of the project would not likely lend to the facilitation of Csikszentmihalyi's optimal experience - flow. However, utilizing the transmedia worlds described by Schell, it is possible that the medical diagnostic and investigative focus of each episode of the series could be the basis for an alternate project that is more truly a game and allows the player to actively participate in the investigation and treatment of a patient. For medical professionals who are passionate about the practice of investigative medicine, the potential for experience of flow might be possible.

Design Process
I knew that my project was going to involve H1N1 vaccination because pandemic preparedness was my initial selection in the course in 2008. Since then, San Diego became “ground zero” in terms of detecting the H1N1 virus and my work has been consumed with the subsequent response to the pandemic. For this project it was possible to combine the primary topic of my professional life at this time with the development of a plausible egame/simulation solution to a gap I identified. The gap, specifically, is the availability of an engaging presentation of the H1N1 information to healthcare providers who are specifically tasked to be vaccinators. As this assignment can be given to them at any time, there frequently is not a lot of time to research or gather information. And ideally, it would be great for them to have the opportunity to practice applying that knowledge in a simulated environment.

Vaccinations are a standard part of day-to-day practice of preventive medicine, particularly in pediatrics, however the launch of a vaccination campaign for H1N1 brought forward 1) a new vaccine in multiple forms and dosages 2) new guidelines specific to the population targeted for initial vaccination which differs from individuals who are typically targeted for seasonal flu vaccination 3) limited supply and distribution issues, 4) varying levels of public knowledge and perceptions of the risks of the virus, and of the vaccine created swiftly to combat the virus. Currently, vaccine information is distributed primarily through official websites and communications. There are hundreds of different guidelines and they are frequently updated to reflect the changes inherent with a new disease process and the response tactics.

Much of the design process took place while reading the course text, The Art of Game Design: A book of lenses by Jesse Schell. The early chapters helped guide me past my usual tendencies to throw out an idea just because I get stuck with how to overcome a certain obstacle. But I decided to stick with my initial topic of H1N1 vaccinations and work through my problem statement of how to make an H1N1 vaccination primer fun, or at least mildly engaging. After experiencing much frustration on how to make that happen, I actually made sudden progress within 30 minutes of reading Schell's chapter on creativity and the value of sleep in creativity.

While doing a random chore I had a sudden burst of thought that led me to placing the worker in a familiar environment that already holds interest and can creatively incorporate the task at hand. Initially I wanted to have it take place on the Starship Enterprise, The Next Generation sickbay under the supervision of Dr. Beverly Crusher. The crew had to travel back in time to the H1N1 pandemic in order to fix a rift in the time-space and they had to beam up inhabitants of Earth to receive their vacination on the ship. As a fan, I've always found the aesthetics of the starship (especially the sounds and crew) comforting. Just as quickly I realized that really wasn't an option as the show had stopped filming in 1994, the characters had aged, and it would not be endearing to those unfamiliar with the series.

However, that thought process immediately led to the selection of House as a modern, interesting world to borrow. At first I felt like I was taking the easy way out by not designing a totally new world, but in continuing with Schell's readings I became convinced that my instincts felt strong in the appropriateness in using an existing and popular fantasy world (with positive critical reviews of the show's medical content) and insert my content into a hopefully brief production process. Even though I am not a graphic artist or a programmer, I found that it was actually more efficient to select existing and simple solutions that would make it easier to produce the video and simple interactive components in time to have it available as quickly as possible. As far as the Elemental Triad is concerned, using the tv show as a transmedia crossover provided for the strength of the aesthetic elements which then suppported the simple storyline and the well-defined guidance (rules and procedures) provided for the basis of the mechanics and thus the underlying technology which would definitely need more definition from experts in that field. With script writers and H1N1 content experts the video could be fast and efficient. Additionally the repurposing of the engine from the P.O.D. game or use of Captivate could also reduce the production time.

Feedback from colleagues consulted on the topic was favorable and helped to determine what details were need to further describe in this document the vision I see clearly in my mind.The most difficult part of this knowing that this process could "loop" endlessly and be all consuming.